National Asthma and Chronic Obstructive Pulmonary Disease ...

National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme (NACAP)
Children and young people asthma organisational audit 2019/20 Resource and organisation of children and young people asthma services in England, Scotland and Wales 2019/20
Organisational audit: data and methodology report
Published May 2021
In association with: Commissioned by:
National Asthma and COPD Audit Programme: Children and young people asthma organisational audit 2019/20
© Healthcare Quality Improvement Partnership 2021 1
The Royal College of Physicians
The Royal College of Physicians (RCP) plays a leading role in the delivery of highquality patient care by setting standards of
medical practice and promoting clinical excellence. The RCP provides physicians in over 30 medical specialties with
education, training and support throughout their careers. As an independent charity representing over 40,000 fellows and
members worldwide, the RCP advises and works with government, patients, allied healthcare professionals and the public
to improve health and healthcare.
Healthcare Quality Improvement Partnership
The National Asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme (NACAP) is commissioned by
the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Patient Outcomes
Programme (NCAPOP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing
and National Voices. Its aim is to promote quality improvement, and in particular, to increase the impact that clinical audit,
outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to
commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising
around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions.
The programme is funded by NHS England, the Welsh government and, with some individual projects, other devolved
administrations and crown dependencies www.hqip.org.uk/national-programmes
NACAP
NACAP is a programme of work that aims to improve the quality of care, services and clinical outcomes for patients with
asthma and COPD in England, Scotland and Wales. Spanning the entire patient care pathway, NACAP includes strong
collaboration with asthma and COPD patients, as well as healthcare professionals, and aspires to set out a vision for a
service which puts patient needs first. To find out more about the NACAP visit: www.rcplondon.ac.uk/nacap
Children and young people asthma: organisational audit of children and young people asthma services in England,
Scotland and Wales 2019/20
This report was prepared by the following people, on behalf of the NACAP asthma advisory group. The full list of members
can be found on the NACAP resources page: www.rcplondon.ac.uk/nacap-cyp-asthma-resources
Professor Ian Sinha, children and young people asthma clinical lead, NACAP; consultant respiratory paediatrician, Alder
Hey Children’s NHS Foundation Trust, Liverpool; honorary associate clinical professor, Division of Child Health, University of
Liverpool
Ms Susan Latchem, programme manager, NACAP, CQID, RCP (April – December 2020)
Ms Lara Amusan, programme manager, NACAP, CQID, RCP
Ms Rachael Andrews, deputy programme manager, NACAP, CQID, RCP
Ms Sharon Afful, project manager, NACAP, CQID, RCP
Ms Eloya Imoedemhe, project manager, NACAP, CQID, RCP
Ms Niamo Yassin, programme coordinator, NACAP, CQID, RCP
Mr Tim Bunning, principal consultant, Crown Informatics
Mr Alex Adamson, research assistant in medical statistics, National Heart and Lung Institute, Imperial College London
Mr Philip Stone, research assistant in statistics/epidemiology, National Heart and Lung Institute, Imperial College London
Professor Jennifer Quint, professor in respiratory epidemiology, National Heart and Lung Institute, Imperial College
London; honorary respiratory consultant, Royal Brompton and Imperial NHS trusts
Professor C Michael Roberts, senior clinical lead, NACAP, CQID, RCP; managing director of academic science partnership,
UCL partners, professor in medical education for clinical practice, Institute of Population Health Sciences, Queen Mary
University London and deputy director of NIHR North Thames Applied Research Collaboration.
Citation for this document: Sinha I, Latchem S, Andrews R, Afful S, Imoedemhe E, Yassin N, Bunning T, Stone P, Adamson A,
Quint J, Roberts CM. National Asthma and COPD Audit Programme: Children and young people asthma organisational audit
2019/20. Organisational audit: Data analysis and methodology report. London: RCP, 2021.
Copyright © Healthcare Quality Improvement Partnership 2021
ISBN: 978-1-86016-831-4
eISBN: 978-1-86016-832-1
Care Quality Improvement Department
11 St Andrews Place
www.rcplondon.ac.uk/nacap-cyp-asthma-2019/20
Contents How to use this report ............................................................................................................................ 3
Recommendations .................................................................................................................................. 5
Section 2: Staffing levels ....................................................................................................................... 12
Section 3: Access to specialist staff and services on weekdays and weekends (7-day working) ......... 16
Section 4: Management of care ............................................................................................................ 27
Section 5: Patient and carer engagement............................................................................................. 30
Section 7: Reimbursement of costs of care .......................................................................................... 34
Section 8: Benchmarked key indicators and participation ................................................................... 36
Appendix A – Methodology .................................................................................................................. 57
Appendix B: BTS/SIGN Management of Asthma Guidelines (2019) ..................................................... 60
Appendix C: NICE 2013 guidelines: Smoking: acute, maternity and mental health services and
Smoking: supporting people to stop ..................................................................................................... 63
Appendix D: Royal of Physicians (RCP), Why Asthma Kills: National Review of Asthma Deaths 63
References ............................................................................................................................................ 65
How to use this report 1. Scope and report structure
This data analysis and methodology report presents the results from an analysis of the data derived
from the children and young people asthma (CYP) organisational audit component of the National
Asthma and COPD Audit Programme (NACAP). Data collection for the organisational audit took place
between 2 December 2019 and 13 March 2020 across England, Scotland and Wales. The audit
collected information on the resourcing and organisation of services relevant to the care of CYP
admitted to hospital with asthma attacks.
These data are presented largely in tabular form with explanatory notes where appropriate. The key
messages and recommendations, as well as an infographic to summarise key data, can be found in
the short national clinical and organisational audit report (via www.rcplondon.ac.uk/nacap-cyp-
asthma-2019/20). Details of the statistical and data collection methodologies used are provided in
Appendix A.
The organisational audit dataset, as well as the resources supplied for both the organisational and
clinical audit (such as FAQs and good practice repositories), can be found via our website:
www.rcplondon.ac.uk/nacap-cyp-asthma-resources
2. Report coverage In total, 110/154 (71%) eligible hospitals in England, 2/14 (14%) eligible hospitals in Scotland and
7/13 (54%) eligible hospitals in Wales provided a full organisational audit record and were included
in the final analysis of this report. A further 23 (13%) hospitals provided partial information but were
not included in the final analysis. Only services which fully completed their organisational audit have
been included in the analysis for this report. For full lists of participating hospitals, part-participating
and non-participating hospitals please see section 8 of this report. Please note that all tables include
a count total/denominator (denoted as n=X) for each column.
This is the first national organisational audit report under the NACAP to report on children and
young people hospital resources and services for asthma therefore no comparative data is available.
The low rate of recruitment to the audit in Scotland provided small numbers (two hospitals) that
cannot be meaningfully analysed as a representative sample of the hospital services available to CYP
in Scotland. Scottish participation in the NACAP CYP ceased in March 2020 following the
discontinuation of commissioning for some major elements of the National Clinical Audit and
Patient Outcomes Programme (NCAPOP).
3. Service-level data The data presented here are provided at national and devolved nation level. In addition, a series of
key indicators at hospital level are presented in section 8 of this report, benchmarking hospitals
against other participating units along with a methodological explanation. No data are provided at
trust or health board level.
Alongside the publication of this report, hospitals have also been provided with site-level reports,
presenting their own service-level data against both the national and relevant devolved nation
average. These reports are provided directly to the hospital team responsible for participation in the
NACAP CYP audits via the NACAP web tool (www.nacap.org.uk). These data will also be made
publicly available at hospital level on the report webpages www.rcplondon.ac.uk/nacap-cyp-
asthma-2019/20 and www.data.gov.uk, in line with the government’s transparency agenda.
4. Audience and links to relevant standards This data analysis and methodology report is intended to be read by healthcare professionals, NHS
managers, chief executives and board members, service commissioners and policy makers, as well as
voluntary organisations and service users. We strongly advise that secondary care teams discuss
these findings between themselves, as well as with their colleagues in primary care, their
commissioners and other relevant healthcare teams. Separate reporting outputs will be produced
for patients and the public and available at: www.rcplondon.ac.uk/nacap-cyp-asthma-2019/20
References to the appropriate British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines
Network (SIGN) guidelines, (Appendix B), National Institute for Health and Care Excellence (NICE)
clinical guidelines and quality statements (Appendix C) and Royal College of Physicians (RCP) Why
asthma still kills: National Review of Asthma deaths (NRAD) recommendations (Appendix D),
relevant to children and young people asthma secondary care, are inserted throughout the report.
Recommendations
National Organisational audit recommendations (OA)
OA1 Nationally there should be a collaborative focus on developing functional regional paediatric asthma
networks to facilitate:
best practice
partnership approaches to the provision of care with appropriate input from different healthcare
sectors and non-healthcare agencies
the involvement of children and young people, parents and carers to support the development of
regional strategies.
These networks should have representation from professional groups, patients and relevant services,
including
For providers of children and young people asthma services
This report outlines two key national quality improvement (QI) priorities for providers of CYP asthma
secondary care.
National QI priority O1: 85% of hospitals should have a respiratory nurse specialist trained in the
care of children and young people with asthma.
National QI priority O2: 80% of hospitals should have access to fractional exhaled nitric oxide
(FeNO) as a diagnostic tool for paediatric asthma services.
For commissioners / health boards / sustainability and
transformation partnerships / integrated care services
Organisational audit recommendations (OA)
OA2 Provide secondary care services with adequate resources to ensure they have a multidisciplinary team
(MDT) for children and young people with asthma. This must include at least:
a paediatric asthma clinical lead
a respiratory nurse specialist with responsibility for inpatient and outpatient management of children and young people with asthma.
O2
O1
For children and young people living with asthma and their families
and carers Organisational audit recommendations (OA)
OA3 Children and young people and their parents and carers should advocate for the universal
implementation of national quality standards across all hospitals.
OA4 Children and young people and their parents and carers should consider participating in strategic groups, including those set up at network level, for paediatric asthma.
Section 1: Admissions – numbers and beds Back to contents
Key findings Between 1 April 2019 and 31 March 2020 (the 2019/20 financial year) the median number of
paediatric medical beds available for use by children and young people (CYP) asthma patients was 22 (interquartile range (IQR): 17–28).
81 out of 119 hospitals have a paediatric high dependency unit (HDU) to which CYP asthma patients can be admitted.
9 out of 119 hospitals have a paediatric intensive care unit (PICU) to which CYP can be admitted.
Navigation This section contains the following tables and graphs. If you are viewing this report electronically, you
can select the table that you wish to view by clicking on the hyperlink from the list below. Please note
the subsection numeration in this section does not align to the question numbering the dataset itself.
Section A: Externally sourced admissions data
A. Number of paediatric medical emergencies in 2019/20 financial year
B. Number of paediatric respiratory coded emergency admissions in the 2019/20 financial
year
C. Number of paediatric asthma coded emergency admissions in the 2019/20 financial year
Section B: Admissions and beds
1.1 How many paediatric medical beds are there in your hospital, which can be used for
paediatric asthma patients?
1.2 Does your hospital have a paediatric high dependency unit(s) (HDU) to which paediatric
asthma patients can be admitted?
1.2.1 How many beds does your paediatric HDU have?
1.3 Does your hospital have a paediatric intensive care unit (PICU) to which paediatric
asthma patients can be admitted?
1.3.1 How many beds does your PICU have?
Part A: Externally sourced admissions data
The following admissions data were collected from existing external datasets, rather than sourced
from hospital teams directly. Externally sourced admissions data were collected to ensure a
reduction in the data collection burden on hospital teams during the organisational audit snapshot
period, as well as to optimise data completeness and accuracy. The following external datasets were
used in this section:
1. NHS Digital Hospital Episodes Statistics (HES) database – for English hospital admissions
data.
2. NHS Wales Informatics Service (NWIS) Patient Episode Database for Wales (PEDW) – for
Welsh hospital admissions data.
Please note that:
Information on CYP aged between 16–18, admitted to adult services and therefore normally
excluded from the CYP audit, were not able to be separated from the data provided by these
existing datasets. Therefore, the data presented in tables A, B and C include ALL CYP patients
aged 1–18 years old.
Admissions data could not be obtained for Scotland in time for the production of this report.
A. Average number of 2019/20 financial year paediatric medical emergency admissions (CYP ages
1–18 years old) per medical bed
2019/20 financial year
Number of paediatric
Median (IQR*) per
medical bed 10.75 (7.2–18.0) 11.1 (7.5–18.0) 4.2 (4.1–12.2)
Mean (SD**) per medical
*Interquartile range
**Standard deviation
B. Average number of 2019/20 financial year paediatric respiratory coded emergency admissions
(CYP aged 1–18 years old) per medical bed
Median (IQR) per
respiratory bed 1.3 (0.8–2.0) 1.3 (0.8–2.1) 0.6 (0.45–1.1)
Mean (SD) per
*Does not include Scotland
C. Average number of 2019/20 financial year paediatric asthma coded emergency admissions per
1,000 paediatric medical emergency admissions (CYP aged 1–18 years old)
Mean (SD) per 1,000 CYP
medical emergency
*Does not include Scotland
Section B: Admissions and beds
The admissions data presented below, as well as all subsequent data, were derived directly from
data collected by hospital teams participating in the NACAP CYP asthma organisational audit. All
tables are numbered in line with the ordering of the organisational audit dataset used during the
snapshot audit between 2 December 2019 and 13 March 2020.
1.1 How many paediatric medical beds are there in your hospital which can be used for CYP
asthma patients?
(n=7)
Median (IQR*) 22 (17–28) 23 (18–28) 6 (0–2)
Mean (SD**) 25.7 (19.6) 27.0 (19.7) 10.3 (11.2)
*Interquartile range **Standard deviation
1.2 Does your hospital have a paediatric high dependency unit(s) (HDU) to which CYP asthma
patients can be admitted?
1.2.1 How many beds does your paediatric HDU have?*
2019/20
HDU
All
Median (IQR) 2 (2–4) 2(2–4) 3.5 (2.5–4.5)
Mean (SD) 3.2 (2.3) 3.2 (2.3) 3.5 (1.3)
*Out of hospitals that had an HDU
1.3 Does your hospital have a paediatric intensive care unit (PICU) to which CYP asthma patients
can be admitted?
Yes 9 (7.6%) 9 (8.2%) 0 (0.0%)
No 110 (92.4%) 101 (91.8%) 7 (100%)
1.3.1 How many beds does your PICU have?*
2019/20
(n=9)
(n=0)
Median (IQR) 10 (8–15) 10 (8–15) 0 (0–0)
Mean (SD) 13.2 (7.9) 13.2 (7.9) 0 (0)
*Out of hospitals that had a PICU
Section 2: Staffing levels Back to contents
Key findings There is a lack of key health professionals in post who can contribute to the care of CYP with asthma. Of participating hospitals:
58.8% have a respiratory nurse specialist
48.7% have a paediatric physiotherapist
29.4% have a paediatric psychologist
76.5% have a paediatric pharmacist.
can select the table that you wish to view by clicking on the hyperlink from the list below.
2.1 How many of each of the following staff posts (filled and unfilled) are there in your acute
paediatric service?
2.2 Number of unfilled posts in acute paediatric service
2.1 How many of each of the following staff posts (filled and unfilled) are there in your acute paediatric service?
Staff posts 2019
WTE
1.1-3.0
Physician posts
FY1/FY2 All (n=119) 13 (10.9%) 17 (14.3%) 53 (44.5%) 36 (30.3%) 3 (1–4) 8 (5–16) 31.65 (20–75)
England (n=110) 9 (8.2%) 16 (14.6%) 51 (46.4%) 34 (30.9%) 3 (2–4) 8 (5–15) 30 (20–72.5)
Wales (n=7) 2 (28.6%) 1 (14.3%) 2 (28.6%) 2 (28.6%) 2 (0–6) 22.2 (0–50) 150 (75–400)
ST1/ST2
All (n=119) 9 (7.6%) 6 (5.0%) 19 (16.0%) 85 (71.4%) 5 (3–8) 17.7 (8.6–37) 75 (36.65–152.5)
England (n=110) 5 (4.6%) 5 (4.6%) 18 (16.4%) 82 (74.6%) 5.4 (3–8) 17.6 (8.6–30) 75 (33.3–150)
Wales (n=7) 2 (28.6%) 1 (14.3%) 1 (14.3%) 3 (42.9%) 2 (0–9) 22.2 (0–100) 200 (125–325)
ST3 and above
All (n=119) 7 (5.9%) 4 (3.4%) 20 (16.8%) 88 (74.0%) 6 (3–8) 20 (9.2–34.3) 82.5 (45.85–178.75)
England (n=110) 5 (4.6%) 2 (1.8%) 17 (15.5%) 86 (78.2%) 6.1 (3.8–8.5) 20 (9.2–33.3) 78.5 (42.5–175)
Wales (n=7) 1 (14.3%) 2 (28.6%) 2 (28.6%) 2 (28.6%) 2 (1–6) 25 (7.7–66.7) 200 (125–290)
Paediatric consultant
All (n=119) 2 (1.7%) 0 (0.0%) 0 (0.0%) 117 (98.3%) 10 (8–13) 40 (26.7–63.3) 172.5 (100–260.85)
England (n=110) 1 (0.9%) 0 (0.0%) 0 (0.0%) 109 (99.1%) 10 (8–13) 37.6 (24.5–54.3) 168.5 (99–250)
Wales (n=7) 0 (0.0%) 0 (0.0%) 0 (0.0%) 7 (100%) 8 (5–8) 155.6 (61.5–200) 450 (333.35–600)
Paediatric respiratory
consultant
All (n=119) 75 (63.0%) 22 (18.5%) 15 (12.6%) 7 (5.9%) 0 (0–1) 0 (0–3.3) 0 (0–20)
England (n=110) 66 (60.0%) 22 (20.0%) 15 (13.6%) 7 (6.4%) 0 (0–1) 0 (0–4) 0 (0–20)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0–0) 0 (0–0) 0 (0–0)
Associate specialist
All (n=119) 86 (72.3%) 20 (16.8%) 10 (8.4%) 3 (2.5%) 0 (0–1) 0 (0–1.5) 0 (0–6.35)
England (n=110) 80 (72.7%) 19 (17.3%) 8 (7.3%) 3 (2.7%) 0 (0–0.7) 0 (0–1.5) 0 (0–4.15)
Wales (n=7) 4 (57.1%) 1 (14.3%) 2 (28.6%) 0 (0.0%) 0 (0–2) 0 (0–15.4) 25 (0–58.35)
Staff grade
All (n=119) 46 (38.7%) 23 (19.3%) 26 (21.9%) 24 (20.2%) 1 (0–3) 3.3 (0–12.5) 14.5 (0–50)
England (n=110) 42 (38.2%) 22 (20.0%) 25(22.7%) 21 (19.1%) 1 (0–3) 3.1 (0–12) 13.65 (0–50)
Wales (n=7) 2 (28.6%) 1 (14.3%) 1 (14.3%) 3 (42.9%) 2 (0–6) 22.2 (0–250) 75 (25–300)
Nurse posts in respiratory team
Asthma nurse specialist
All (n=119) 49 (41.2%) 43 (36.1%) 22 (18.5%) 5 (4.2%) 0.7 (0–1) 1.4 (0–5) 6.5 (0–25)
England (n=110) 45 (40.9%) 41 (37.3%) 19 (17.3%) 5 (4.6%) 0.65 (0–1) 1.3 (0–4.4) 6 (0–23.15)
Wales (n=7) 3 (42.9%) 2 (28.6%) 2 (28.6%) 0 (0.0%) 1 (0–2) 7.7 (0–15.4) 75 (41.65–150)
Due to rounding of percentages some lines of data may not add up to 100 *Admissions data includes ALL CYP patients between 1–18 years old but does not include Scotland
Nurse consultant
/other specialist nurse
All (n=119) 88 (74.0%) 13 (10.9%) 10 (8.4%) 8 (6.7%) 0 (0–0.6) 0 (0–0.5) 0 (0–3.8)
England (n=110) 79 (71.8%) 13 (11.8%) 10 (9.1%) 8 (7.3%) 0 (0–0.8) 0 (0–1) 0 (0–4.65)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0–0) 0 (0–0) 0 (0–0)
Other healthcare professional posts
/paediatric
physiotherapist
All (n=119) 61 (51.3%) 38 (31.9%) 12 (10.1%) 8 (6.7%) 0 (0–1) 0 (0–3.3) 0 (0–22.5)
England (n=110) 55 (50.0%) 36 (32.7%) 11 (10.0%) 8 (7.3%) 0.05 (0–1) 0 (0–3.3) 0 (0–20)
Wales (n=7) 5 (71.4%) 1 (14.3%) 1 (14.3%) 0 (0.0%) 0 (0–1) 0 (0–7.7) 16.65 (0–56.65)
Paediatric psychologist
All (n=119) 84 (70.6%) 24 (20.2%) 9 (7.6%) 2 (1.7%) 0 (0–0.6) 0 (0–0.6) 0 (0–3.65)
England (n=110) 76 (69.1%) 24 (21.8%) 8 (7.3%) 2 (1.8%) 0 (0–0.8) 0 (0–0.7) 0 (0–4.65)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0–0) 0 (0–0) 0 (0–0)
Paediatric pharmacist
All (n=119) 28 (23.5%) 74 (62.2%) 15 (12.6%) 2 (1.7%) 1 (0.2–1) 3.1 (0.4–5.7) 13.3 (2.25–25)
England (n=110) 25 (22.7%) 68 (61.8%) 15 (13.6%) 2 (1.8%) 1 (0.3–1) 2.9 (0.4–5) 12.3 (2–25)
Wales (n=7) 2 (28.6%) 5 (71.4%) 0 (0.0%) 0 (0.0%) 1 (0–1) 7.7 (0–11.1) 50 (41.65–75)
Other – not listed
All (n=119) 111 (93.3%) 3 (2.5%) 3 (2.5%) 2 (1.7%) 0 (0–0) 0 (0–0) 0 (0–0)
England (n=110) 102 (92.7%) 3 (2.7%) 3 (2.7%) 2 (1.8%) 0 (0–0) 0 (0–0) 0 (0–0)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0–0) 0 (0–0) 0 (0–0)
2.2 Number of unfilled posts in acute paediatric service
Staff post 2019
FY1/FY2
All (n=119) 111 (93.3%) 7 (5.9%) 1 (0.8%) 0 (0.0%)
England (n=110) 103 (93.6%) 7 (6.4%) 0 (0.0%) 0 (0.0%)
Wales (n=7) 6 (85.7%) 0 (0.0%) 1 (14.3.0%) 0 (0.0%)
ST1/ST2
All (n=119) 88 (74.0%) 19 (16.0%) 11 (9.2%) 1 (0.8%)
England (n=110) 80 (72.7%) 19 (17.3%) 11 (10.0%) 0 (0.0%)
Wales (n=7) 6 (85.7%) 0 (0.0%) 0 (0.0%) 1 (14.3%)
ST3 and above
All (n=119) 53 (44.5%) 27 (22.7%) 29 (24.4%) 10 (8.4%)
England (n=110) 49 (44.6%) 25 (22.7%) 26 (23.6%) 10 (9.1%)
Wales (n=7) 3 (42.9%) 2 (28.6%) 2 (28.6%) 0 (0.0%)
Paediatric consultant
All (n=119) 85 (71.4%) 17 (14.3%) 12 (10.1%) 5 (4.2%)
England (n=110) 81 (73.6%) 16 (14.6%) 10 (9.1%) 3 (2.7%)
Wales (n=7) 3 (42.9%) 0 (0.0%) 2 (28.6%) 2 (28.6%)
Paediatric respiratory
consultant
All (n=119) 116 (97.5%) 3 (2.5%) 0 (0.0%) 0. (0.0%)
England (n=110) 107 (97.3%) 3 (2.7%) 0 (0.0%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Associate specialist
All (n=119) 114 (95.8%) 4 (3.4%) 1 (0.8%) 0 (0.0%)
England (n=110) 106 (96.4%) 4 (3.6%) 0 (0.0%) 0 (0.0%)
Wales (n=7) 6 (85.7%) 0 (0.0%) 1 (14.3%) 0 (0.0%)
Staff grade
All (n=119) 101 (84.9%) 7 (5.9%) 7 (5.9%) 4 (3.4%)
England (n=110) 94 (85.5%) 7 (6.4%) 6 (5.5%) 3 (2.7%)
Wales (n=7) 5 (71.4%) 0 (%) 1 (14.3%) 1 (14.3%)
Unfilled nurse posts
Asthma nurse specialist
All (n=119) 106 (89.1%) 13 (10.9%) 0 (0.0%) 0 (0.0%)
England (n=110) 97 (88.2%) 13 (11.8%) 0 (0.0%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Nurse consultant/other
specialist nurse
All (n=119) 115 (96.6%) 3 (2.5%) 1 (0.8%) 0 (0.0%)
England (n=110) 106 (96.4%) 3 (2.7%) 1 (0.9%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Unfilled other healthcare professional posts in respiratory team
Specialist
respiratory/paediatric
physiotherapist
All (n=119) 114 (95.8%) 3 (2.5%) 2 (1.7%) 0 (0.0%)
England (n=110) 105 (95.5%) 3 (2.7%) 2 (1.8%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Paediatric psychologist
All (n=119) 111 (93.3%) 8 (6.7%) 0 (0.0%) 0 (0.0%)
England (n=110) 102 (92.7%) 8 (7.3%) 0 (0.0%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Paediatric pharmacist
All (n=119) 114 (95.8%) 4 (3.4%) 1 (0.8%) 0 (0.0%)
England (n=110) 105 (95.5%) 4 (3.6%) 1 (0.9%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Other – not listed
All (n=119) 119 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
England (n=110) 110 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
Wales (n=7) 7 (100%) 0 (0.0%) 0 (0.0%) 0 (0.0%)
National QI priority O1: 85% of hospitals should have a respiratory nurse specialist trained in the
care of children and young people with asthma.
Rationale
part of an MDT was associated with improvements
in care. These improvements are noted on page 23
of the combined clinical and organisational audit
report. Further evidence of improvements in care
led by specialist nurses can be seen in the case
studies on page 17, page 25 and page 27, in the
combined report.
with asthma in several ways.
In the inpatient setting they can be
involved in the acute management and
discharge planning of CYP with asthma.
In clinics, they can provide education for
CYP and families to empower self-
management, conduct physiological
independent practitioners. This is
important because general paediatric
to do thoroughly.
ward, emergency department, and
such as audit.
transition to adult services.
physiotherapists, pharmacists, physician associates,
CYP with asthma but they are unlikely to be a
protected resource for CYP with asthma in district
general hospital settings, and may be better utilised
in the management of uncontrolled and severe
asthma.
The main step in this process is to develop a
business case for a respiratory specialist nurse.
Developing a business case for an asthma
specialist nurse could initially focus on clinical
benefits: improving the quality of care given to
CYP may reduce length of stay, and better
education before discharge will reduce the
rates of readmission. Centres without asthma
specialist nurses could work with their local
business intelligence team to identify the rates
of reattendance and readmission, which can be
a useful baseline for calculating cost savings.
Use NACAP benchmarking data from the
clinical and organisational audit to highlight the
need for an asthma specialist nurse. The data
suggest that developing an MDT improves the
quality of care for CYP.
Involve CYP and their parents and carers in
identifying the benefits of having an asthma
specialist nurse in your department.
O1
Section 3: Access to specialist staff and services on weekdays and weekends (7-day working)
Back to contents
Key standards
BTS/SIGN 2019 [3.3.4] In adults and children with an intermediate probability of asthma and
normal spirometry results, undertake challenge tests and/or measurement of FeNO to
identify eosinophilic inflammation.1
BTS/SIGN 2019 [6.2.3] People with asthma and parents/carers of children with asthma should
be advised about the dangers of smoking and second-hand tobacco smoke exposure, and
should be offered appropriate support to stop smoking.1
BTS/SIGN 2019 [6.2.9]: Weight-loss interventions (including dietary and exercise-based
programmes) can be considered for overweight and obese adults and children with asthma to
improve asthma control.1
BTS/SIGN 2019 [10.1]: Patients with difficult asthma should be systematically evaluated,
including: confirmation of the diagnosis of asthma and identification of the mechanism of
persisting symptoms and assessment of adherence to therapy.
The assessment should be facilitated through dedicated multidisciplinary difficult asthma
service, by a team experienced in assessment and management of difficult asthma.1
NICE 2017 Asthma: diagnosis monitoring and chronic asthma management NG80 [1.3.3]
Consider a FeNO test in children and young people (aged 5–16) if there is diagnostic
uncertainty after initial assessment and they have either: normal spirometry or obstructive
spirometry with a negative bronchodilator reversibility (BDR) test.2
NICE 2013 Smoking: acute, maternity and mental health services PH48 [Recommendation 5]
Provide information and advice for carers, family, other household members and hospital
visitors.3
NICE 2013 Smoking: supporting people to stop QS43 [QS2] People who smoke are offered a
referral to an evidence-based smoking cessation service.4
NRAD 2014 why asthma still kills: organisation of NHS services [Recommendation 1] Every
hospital and general practice should have a designated, named clinical lead for asthma
services, responsible for formal training and management of acute asthma.6
NRAD 2014 why asthma still kills: organisation of NHS services [Recommendation 2] Patients
with asthma must be referred to a specialist asthma service if they have required more than
two courses of systemic corticosteroids, oral or injected, in the previous 12 months or require
management using British Thoracic Society (BTS) stepwise treatment 4 or 5 to achieve
control.6
NRAD 2014 why asthma still kills: patient factors and perception of risk [Recommendation 2]
A history of smoking and/or exposure to second-hand smoke should be documented in the
medical records of people with asthma. Current smokers should be offered referral to a
smoking cessation service.6
Key findings Local and network asthma care and leadership
Of participating hospitals:
69.8% are part of a regional paediatric asthma networki
80.7% have a designated lead for paediatric asthma services (either as a designated paediatric lead
or lead for both adult and paediatric services)
68.9% have a specific service for paediatric asthma
49.9% of their admitted CYP asthma patients have access to a paediatric respiratory nurse
specialist. However, at weekends only 5.2% of centres have a respiratory nurse specialist available
for CYP.
CYP
Of participating hospitals:
72.3% have a smoking cessation service to which they signpost parents, carers or CYP asthma
patients as required
52.1% have a smoking cessation service to which they can refer CYP asthma patients
30.3% have a dedicated service for childhood obesity to which they can refer patients.
Access to physiology services
89.9% have access to spirometry
41.2% have access to fractional exhaled nitric oxide (FeNO), as a diagnostic tool for CYP asthma patients.
i For further information on paediatric networks, please refer to section 3 (3.45, 3.46, 3.47 and 3.5) of the NHS Long Term Plan: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
3.1 On which days does a senior decision maker from paediatric team (ST3 or above) undertake
a ward round of new CYP asthma patients on the paediatric admissions unit (PAU)?
3.1.1 How often are CYP patients on the paediatric admissions ward routinely reviewed by a
senior decision maker (ST3 or above)?
3.2 On which days does a senior decision maker from paediatric team (ST3 or above) undertake
a ward round of new CYP asthma patients on the paediatric ward(s)?
3.3 Which admitted CYP asthma patients have access to a paediatric respiratory nurse?
3.3.1 On which days is the respiratory nurse(s) available to review CYP asthma patients?
3.4 What is your hospital’s access to an on-call paediatric respiratory consultant for CYP asthma
patients?
3.5 On which days does your hospital provide a PICU outreach service for critically ill CYP
patients requiring PICU management?
3.6 Is your service part of a regional paediatric asthma network?
3.7 Does your hospital have a designated named clinical lead for asthma services?
- 3.7.1 Is this role currently filled?
- 3.7.2 Is the asthma lead responsible for formal training in the management of acute
paediatric asthma?
3.8 Does your hospital have a specific service for paediatric asthma?
- 3.8.1 If no, do you have set criteria for referral to an offsite specialist paediatric asthma
service?
3.9 When CYP with poor asthma control or severe illness have been identified in clinic, does the
asthma lead review the CYP prior to referral to a specialist paediatric asthma service?
3.10. Is there a smoking cessation service to which you can refer or signpost parents/carers of
your CYP asthma patients?
- 3.10.1 Please let us know more about the provision of this service
3.11 Is there a smoking cessation service to which you can refer CYP asthma patients?
- 3.11.1 Please tell us more about the provision of this service
3.12 Do you have a dedicated service for childhood obesity to which your CYP patients can be
referred?
3.13 Can the paediatric team refer CYP patients to a home-based community service post
discharge?
3.14 In your hospital, do you have access to following diagnostic tools for CYP asthma patients?
3.1 On which days does a senior decision maker from paediatric team (ST3 or above) undertake a
ward round of new CYP asthma patients on the paediatric admission unit (PAU)?
2019/20
asthma patients
Out of hours ** 74 (62.2%) 71 (64.6%) 3 (42.9%)
None 7 (5.9%) 5 (4.6%) 1 (14.3%)
Services that did not have paediatric admissions unit (PAU) were advised to leave this question blank. Please note that this question followed a tick all that apply format *Weekends are defined as between 18:30 on a Friday until 08:00 on a Monday **Out of hours are defined as 18:30–08:00 on weekdays
3.1.1 How often are CYP patients on the paediatric admissions ward routinely reviewed by a
senior decision maker (ST3 or above)?
2019/20
Daily 67 (56.3%) 62 (56.4%) 3 (42.9%)
Other 3 (2.5%) 2 (1.8%) 1 (14.3%)
At weekends?
Daily 83 (69.8%) 77 (70.0%) 4 (57.1%)
Other 4 (3.4%) 3 (2.7%) 1 (14.3%)
Due to rounding of percentages some lines of data may not add up to 100
3.2 On which days does a senior decision maker from paediatric team (ST3 or above) undertake a
ward round of new CYP asthma patients on the paediatric ward(s)?
2019/20
Out of hours** 68 (57.1%) 65 (59.1%) 3 (42.9%)
None 2 (1.7%) 1 (0.9%) 1 (14.3%)
Please note that this question followed a tick all that apply format *Weekends are defined as between 18:30 on a Friday until 08:00 on a Monday **Out of hours are defined as 18:30–08:00 on weekdays
3.3 Which admitted CYP asthma patients have access to a paediatric respiratory nurse?
2019/20
All CYP asthma patients 59 (49.6%) 54 (49.1%) 4 (57.1%)
Those under the care of a
paediatric respiratory
Other 12 (10.1%) 12 (10.9%) 0 (0.0%)
3.3.1 On which days is a respiratory nurse(s) available to review paediatric asthma inpatients?*
2019/20
Out of hours *** 0 (0.0%) 0 (0.0%) 0 (0.0%)
No paediatric respiratory
nurse available 4 (5.2%) 4 (5.6%) 0 (0.0%)
Please note that this question followed a tick all that apply format *Out of hospitals with access to respiratory nurse **Weekends are defined as between 18:30 on a Friday until 08:00 on a Monday ***Out of hours are defined as 18:30–08:00 on weekdays
3.4 What is your hospital’s access to an on-call paediatric respiratory consultant for CYP asthma
patients?
2019/20
On the phone 40 (33.6%) 38 (34.6%) 2 (28.6%)
Regional outreach service 54 (45.4%) 52 (47.3%) 2 (28.6%)
This was a tick all that apply question and a number of respondents left it blank, therefore it is not possible say with
certainty how many hospitals do not have access to an on-call paediatric respiratory consultant or just left the question
blank. However, from the responses given we have deduced that approximately 23.5% of hospitals do not have access to an
on-call paediatric respiratory consultant.
3.5 On which days does your hospital provide a PICU outreach service for critically ill CYP requiring
PICU management?
Out of hours** 18 (15.1%) 18 (16.4%) 0 (0.0%)
No outreach service 100 (84.0%) 91 (82.7%) 7 (100%)
Please note that this question followed a tick all that apply format *Weekends are defined as between 18:30 on a Friday until 08:00 on a Monday **Out of hours are defined as 18:30 – 08:00 on weekdays
3.6 Is your service part of a regional paediatric asthma network?
2019/20
Not known 6 (5.0%) 6 (5.5%) 0 (0.0%)
3.7 Does your hospital have a designated named clinical lead for asthma services?
2019/20
Single lead for both
No lead 19 (16.0%) 18 (16.4%) 0 (0.0%)
Services that have different clinical leads for paediatric and adult asthma were advised to select ‘paediatric lead only’ Due to rounding of percentages for the purposes of presenting this data some lines of data may not add up to 100
3.7.1 Is the designated named clinical lead role currently filled?*
2019/20
(n=100)
Not known 2 (2.0%) 2 (2.2%) 0 (0.0%)
Due to rounding of percentages some lines of data may not add up to 100 *Out of hospitals that had a designated named clinical lead
3.7.2 Is the asthma lead responsible for formal training in the management of acute paediatric
asthma?*
2019/20
Yes – paediatric and adult 6 (6.0%) 6 (6.5%) 0 (0.0%)
No 21 (21.0%) 20 (21.7%) 0 (0.0%)
*Out of hospitals that had a designated named clinical lead
3.8 Does your hospital have a specific service for paediatric asthma?
2019/20
Not known 2 (1.7%) 2 (1.8%) 0 (0.0%)
3.8.1 If not, do you have set criteria for referral to an off-site specialist paediatric asthma service?*
2019/20
offsite specialist
Yes 18 (48.7%) 18 (52.9%) 0 (0.0%)
No 19 (51.4%) 16 (47.1%) 3 (100%)
*Out of hospitals that did not have a specific service for paediatric asthma or selected not known
3.9 When CYP with poor asthma control or severe illness have been identified in clinic, does the
asthma lead review the CYP prior to referral to a specialist paediatric asthma service?*
2019/20
specialist paediatric
asthma service
Not applicable – we have
specialist advice on site 11 (11.0%) 10 (10.9%) 0 (0.0%)
Not known 9 (9.0%) 6 (6.5%) 3 (42.9%)
Due to rounding of percentages some lines of data may not add up to 100 *Out of hospitals that had a designated named clinical lead
3.10 Is there a smoking cessation service to which you can refer or signpost parents/carers of your
CYP asthma patients?
Not known 13 (10.9%) 13 (11.8%) 0 (0.0%)
3.10.1 Please let us know more about the provision of this service*
2019/20
Both hospital and
Single team that works
9 (10.5%) 5 (6.41%) 3 (50.0%)
Services that have both hospital and community- based teams and a single team that works across the community secondary care interface were advised to select the ‘single team that works across the community/secondary care interface’ option Due to rounding of percentages some lines of data may not add up to 100 *Out of hospitals with a smoking cessation service they can signpost parents/carers to
3.11 Is there a smoking cessation service to which you can refer CYP asthma patients?
2019/20
Not known 15 (12.6%) 13 (11.8%) 2 (28.6%)
3.11.1 Please let us know more about the provision of this service*
2019/20
Both hospital and
Single team that works
7 (11.3%) 6 (10.3%) 0 (0.0%)
*Out of hospitals with a smoking cessation service they can signpost CYP asthma patients to
3.12 Do you have a dedicated service for childhood obesity, to which your CYP asthma patients can be referred?
2019/20
Not known 1 (0.8%) 1 (0.9%) 0 (0.0%)
3.13 Can the paediatric team refer CYP asthma patients to a home-based community service post
discharge?
2019/20
Not known 1 (0.8%) 1 (0.9%) 0 (0.0%)
3.14 In your hospital, do you have access to the following diagnostic tools for CYP asthma
patients?
2019/20
asthma
All
Peak expiratory flow (PEF) 116 (97.5%) 107 (97.3%) 7 (100%)
Fractional exhaled nitric oxide (FeNO) 49 (41.2%) 48 (43.6%) 1 (14.3%)
Skin prick test 102 (85.7%) 96 (87.3%) 4 (57.1%)
None 1 (0.8%) 1 (0.9%) 0 (0.0%)
National QI priority O2: 80% of hospitals should have access to fractional exhaled nitric oxide
(FeNO) as a diagnostic tool for paediatric asthma services.
Rationale
in cases of equivocal diagnosis of asthma than
measures of airway obstruction (such as PEFR). In
the largest UK cohort study evaluating different
physiological tests for asthma in CYP, FeNO
emerged as the most useful first thing to measure.ii
FeNO is mandated in the NICE guidelines as a
necessary test in the asthma diagnosis pathway,
and recommended as a useful test in the BTS
guidelines, BTS/SIGN 2019 [3.3.4].The accurate
identification of asthma in children is important,
and the NICE guidelines evaluation has shown that
despite an initial investment it is a cost-effective
approach to diagnosis.
departments to identify if this is a service
they can offer. If not, use successful
business cases from neighbouring centres
in your network for ideas.
Refer to NICE guidelines which advocate
the use of FeNO in the diagnosis of
asthma. NICE NG80 [1.3.3]
appropriate training in the conduct of the
test and maintenance of the machines.
Section 4: Management of care Back to contents
Key standard:
BTS/SIGN Asthma Guidelines 2019 [9.7.2]: Consider intensive inpatient treatment of children with SpO2 <92% in air after initial bronchodilator treatment.1
Key findings Of participating hospitals:
52.9% have a paediatric oxygen policy
74.8% have ward based paediatric medication charts with a designated space to record the prescription of oxygen
99.2% use a paediatric early warning system (PEWS)
72% utilise a PEWS which incorporates space to record subjective nursing concerns about a patient’s clinical status.
4.1 Does the paediatric service in your hospital have an Electronic Patient Record (EPR) system?
4.2 Does your hospital have a paediatric oxygen policy?
4.3 Do the ward-based paediatric medication charts/records have a designated place in which to
record the prescription of oxygen?
4.4 Does your hospital use a system of paediatric early warning detection, eg PEWS?
- 4.4.1 Does your early warning detection system allow the following to be recorded?
- 4.4.2 Does your early warning detection system incorporate a section in which nurses can
record a qualitative measure of how worried they are about the child/young adult?
4.1 Does the paediatric service in your hospital have an Electronic Patient Record (EPR) system?
2019/20
4.2 Does your hospital have a paediatric oxygen policy?
2019/20
Yes – combined adult and
Neither a paediatric nor
Not known 22 (18.5%) 19 (17.3%) 3(42.9%)
Services with adult policy only were advised to select neither paediatric nor adult
4.3 Do the ward-based paediatric medication charts/records have a designated place in which to
record the prescription of oxygen?
2019/20
Yes 89 (74.8%) 83 (75.5%) 4 (57.1%)
No 30 (25.2%) 27 (24.6%) 3 (42.9%)
4.4 Does your hospital use a system of paediatric early warning detection, eg PEWS?
2019/20
Yes 118 (99.2%) 110 (100%) 6 (85.7%)
No 1 (0.8%) 0 (0.0%) 1 (14.3%)
4.4.1 Does your early warning detection system allow the following to be recorded?*
2019/20
Amount of oxygen
None of the above 1 (0.9%) 1 (0.9%) 0 (0.0%)
*Out of hospitals with a PEWS system
4.4.2 Does your early warning detection system incorporate a section in which nurses can record a
qualitative measure of how worried they are about the CYP?*
2019/20
Not known 4 (3.4%) 4 (3.6%) 0 (0.0%)
*Out of hospitals with a PEWS system
Section 5: Patient and carer engagement Back to contents
Key findings Of participating hospitals
17.7% have a strategic group for paediatric asthma services
23.8% have strategic groups that include a CYP or a parent/carer of a CYP with asthma
87.4% routinely conduct surveys of parent/carer views on paediatric services. Of these, 35.3% of
hospitals conduct this on a continuous basis with all patients.
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5.1 Does your trust have a strategic group for paediatric asthma services?
- 5.1.1 If yes, does this group have CYP or parent/carer representation?
5.2 How often is a formal survey seeking patient and parent/carer views on paediatric
services undertaken?
5.1 Does your trust have a strategic group for paediatric asthma services?
2019/20
Not known 4 (3.4%) 4 (3.6%) 0 (0.0%)
5.1.1 If yes, does this group have CYP or parent/carer representation?*
2019/20
Not known 3 (14.3%) 2 (11.8%) 0 (0.0%)
*Out of hospitals that have strategic group for paediatric asthma services
5.2 How often is a formal survey seeking CYP and parent/carer views on paediatric services
undertaken?
2019/20
Continuous (every patient) 42 (35.3%) 41 (37.3%) 1 (14.3%)
More than 4 times a year 14 (11.8%) 13 (11.8%) 1 (14.3%)
3–4 times a year 2 (1.7%) 2 (1.8%) 0 (0.0%)
1–2 times a year 19 (16.0%) 19 (17.3%) 0 (0.0%)
Less than once a year 27 (22.7%) 25 (22.7%) 1 (14.3%)
Never 15 (12.6%) 10 (9.1%) 4 (57.1%)
Section 6: Transitional care Back to contents
Key standards
BTS/SIGN 2019 [11.11.3]: In the initial period after transition to adult services in secondary
care, adolescents are best seen by one consultant to build their confidence and encourage
attendance.1
BTS/SIGN 2019 [11.11.4]: Transition should be seen as a process and not just the event of
transfer to adult services. It should begin early, be planned, involve the young person and be
both age and developmentally appropriate.
Young people should be given the opportunity to be seen without their parents/carers.
Transition services must address the needs of parents/carers whose role in their child’s
life is evolving at this time.
Transition services must be multidisciplinary and multi-agency. Optimal care requires a
cooperative working relationship between adult and paediatric services, particularly
where the young person has complex needs with multiple specialty involvement.
Coordination of transitional care is critical. There should be an identified coordinator who
supports the young person until he or she is settled within the adult system.
Young people should be encouraged to take part in transition/support programmes
and/or put in contact with other appropriate youth support groups.
The involvement of adult physicians prior to transfer supports attendance and adherence
to treatment.
Transition services must undergo continued evaluation.1
BTS/SIGN 2019 [11.12.1]: Design of individual or group education sessions delivered by
healthcare professionals should address the needs of adolescents with asthma.1
Key finding 52.1% of hospitals have formal transitioning processes in place for young people transitioning from
paediatric to adult services.
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6.1 Do your processes for transitioning young people from paediatric to adult services include
ensuring that
6.1 Do your processes for transitioning young people from paediatric to adult service include
ensuring that:
services
All
of their condition 50 (42.0%) 46 (41.8%) 3 (42.9%)
The GP is sent the same record 56 (47.1%) 51 (46.4%) 4 (57.1%)
The young person is given the
opportunity to be seen without
their parents/carers
addressed 59 (49.6%) 55 (50.0%) 3 (42.9%)
The young person has a transition
plan that has been agreed with both
paediatric and adult clinicians
coordinator/case worker to support
system
We provide individual/group
21 (17.7%) 20 (18.2%) 0 (0.0%)
The transition service undergoes
We do not have any formal
transition arrangements 57 (47.9%) 53 (48.2%) 3 (42.9%)
Please note that this question followed a tick all that apply format
Section 7: Reimbursement of costs of care Back to contents
Key findings Of participating hospitals:
52.9% receive reimbursement of costs for CYP asthma patients through block contracts.
95.8% do not have a CQUIN (Commissioning for Quality Innovation) or LIP (Local Incentive Payment) for CYP asthma care.
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can select the table you wish to view by clicking on the hyperlink from the list below.
7.1 How is reimbursement of costs of care for CYP patients with asthma achieved?
7.2 Has your commissioner/health board agreed a Commissioning for Quality and Innovation
(CQUIN) payment of Local Incentive Payment (LIP) in relation to paediatric asthma care?
7.1 How is reimbursement of costs of care for CYP patients with asthma achieved?
2019/20
Payment by results 27 (22.7%) 27 (24.6%) 0 (0.0%)
Locally negotiated tariff 14 (11.8%) 12 (10.9%) 1 (14.3%)
Other 15 (12.6%) 9 (8.2%) 5 (71.4%)
7.2 Has your commissioner/health board agreed a Commissioning for Quality and Innovation
(CQUIN) payment of Local Incentive Payment (LIP) in relation to CYP asthma care?iii
2019/20
place for CYP asthma
Yes 5 (4.2%) 5 (4.6%) 0 (0.0%)
No 114 (95.8%) 105 (95.5%) 7 (100%)
iii There is a severe asthma CQUIN in place. This is not applicable to all hospitals. Please refer to
https://www.england.nhs.uk/publication/pss8-severe-asthma-flat-final-pss-cquin-indicator/ for further information.
Section 8: Benchmarked key indicators and participation
Back to contents
8.1 Benchmarking of key indicators for participating hospitals
Table 1 presents the indicators that have been selected for benchmarking, as well as the criteria required for hospitals to meet each indicator based on the
answer options provided in the children and young people (CYP) asthma organisational audit dataset.
Table 2 presents whether each hospital meets each indicator (target met – coloured light green) or not (target not met – coloured light pink). Please note
that hospitals that are not currently registered for the CYP audit were excluded from benchmarking analyses.
Table 1. Methodology for benchmarking key indicators
Benchmarking dashboard performance indicator Rationale
Process items
Does your hospital have a paediatric high dependency unit (HDU) to which CYP asthma patients can be admitted? (Q1.2)
A proportion of CYP admitted to hospital will have refractory asthma with life-threatening features and will probably require admission to an HDU for intravenous therapy and support.
Does your hospital have a designated, named clinical lead for asthma services? (Q3.7)
One of the recommendations from the National Review of Asthma Deaths (NRAD) was that healthcare facilities should identify a lead person for asthma.
The approaches and requirements of asthma services will vary between CYP and adult care.
Is there a smoking cessation service to which you can refer or signpost parents/carers of your CYP asthma patients? (Q3.10)?
Smoking and exposure to second-hand smoke is a big risk factor for acute asthma attacks and also for accelerated lung function decline and development of COPD later on in life. Nicotine is one of the most addictive substances in the world and specialist services are shown to improve rates of smoking cessation. Smoking cessation approaches for CYP will differ from those effective in adults.
Maps to BTS/SIGN 2019 [6.2.3]
Is there a smoking cessation service to which you can refer CYP asthma patients? (Q3.11)
Smoking and exposure to second-hand smoke is a big risk factor for acute asthma attacks and also for accelerated lung function decline and development of COPD later on in life. Nicotine is one of the most addictive substances in the world and specialist services are shown to improve rates of smoking cessation. Smoking cessation approaches for CYP will differ from those effective in adults.
Maps to BTS/SIGN 2019 [6.2.3]
In your hospital, do you have access to the following diagnostic tools for CYP asthma patients? (Q3.14) (spirometry and fractional exhaled nitric oxide (FeNO)
These are recommended in NICE guidelines as useful tool for accurately making a diagnosis of asthma in CYP and adults.
Maps to NICE NG80 [1.3.3]
Table 2. Unadjusted benchmarking of key indicators for hospitals in England, Scotland and Wales
Trust name / local health board Service name HDU on site
Smoking
England
Airedale NHS Foundation Trust Airedale General Hospital No No Yes No No
Ashford and St Peter’s Hospitals NHS
Foundation Trust St Peter’s Hospital Yes Yes No Yes No
Barking, Havering and Redbridge University
Hospitals NHS Trust King George Hospital
No Yes No Yes No
Barking, Havering and Redbridge University
Hospitals NHS Trust Queen’s Hospital Romford Yes Yes No No No
Barnsley Hospital NHS Foundation Trust Barnsley District General
Hospital Yes Yes Yes Yes No
Barts Health NHS Trust Newham General Hospital Yes Yes Yes No No
Smoking
Basildon and Thurrock University Hospitals NHS
Foundation Trust Basildon Hospital No Yes Yes Yes Yes
Bedford Hospital NHS Trust Bedford Hospital Yes Yes No No No
Birmingham Women’s and Children’s NHS
Foundation Trust
Hospital Yes Yes No No Yes
Bolton NHS Foundation Trust Royal Bolton Hospital Yes No Yes Yes Yes
Bradford Teaching Hospitals NHS Foundation
Trust Bradford Royal Infirmary No Yes Yes No Yes
Brighton and Sussex University Hospitals NHS
Trust
Hospital Yes Yes Yes Yes No
Buckinghamshire Healthcare NHS Trust Stoke Mandeville Hospital No No Yes No No
Smoking
Calderdale and Huddersfield NHS Foundation
Trust Calderdale Royal Hospital No Yes Yes Yes Yes
Chelsea and Westminster Hospital NHS
Foundation Trust
Chesterfield Royal Hospital NHS Foundation
Trust Chesterfield Royal
Foundation Trust Darlington Memorial Hospital Yes Yes Yes No Yes
County Durham and Darlington NHS
Foundation Trust
Durham No Yes Yes Yes Yes
Dartford and Gravesham NHS Trust Darent Valley Hospital No Yes No No No
Doncaster and Bassetlaw Teaching Hospitals
NHS Foundation Trust
Bassetlaw District General
Doncaster and Bassetlaw Teaching Hospitals
NHS Foundation Trust Doncaster Royal Infirmary Yes Yes Yes Yes Yes
Smoking
Indicator no. 1 2 3 4 5
Dorset County Hospital NHS Foundation Trust Dorset County Hospital Yes Yes Yes Yes No
East Kent Hospitals University NHS Foundation
Trust
East Kent Hospitals University NHS Foundation
Trust William Harvey Hospital
Yes Yes Yes Yes No
East Lancashire Hospitals NHS Trust Royal Blackburn Hospital No Yes No No Yes
East Sussex Healthcare NHS Trust Conquest Hospital No Yes Yes No No
Epsom and St Helier University Hospitals NHS
Trust Epsom Hospital
Epsom and St Helier University Hospitals NHS
Trust St Helier Hospital No Yes No No No
Frimley Health NHS Foundation Trust Frimley Park Hospital Yes No Yes Yes No
Smoking
Frimley Health NHS Foundation Trust Wexham Park Hospital Yes Yes Yes No Yes
George Eliot Hospital NHS Trust George Eliot Hospital Yes Yes Yes Yes Yes
Guy’s and St Thomas’ NHS Foundation Trust St Thomas’ Hospital Yes Yes Yes Yes Yes
Hampshire Hospitals NHS Foundation Trust Basingstoke and North
Hampshire Hospital Yes Yes Yes Yes No
Hampshire Hospitals NHS Foundation Trust Royal Hampshire County
Hospital No Yes Yes No No
Harrogate and District NHS Foundation Trust Harrogate District Hospital Yes Yes Yes Yes Yes
Homerton University Hospital NHS Foundation
Trust Homerton Hospital No Yes Yes Yes No
Hull University Teaching Hospitals NHS Trust Hull Royal Infirmary Yes Yes Yes Yes Yes
Smoking
Imperial College Healthcare NHS Trust St Mary’s Hospital, Paddington Yes Yes Yes Yes Yes
King’s College Hospital NHS Foundation Trust Princess Royal University
Hospital (Bromley) No Yes Yes No No
Kingston Hospital NHS Foundation Trust Kingston Hospital Yes Yes Yes No No
Lancashire Teaching Hospitals NHS Foundation
Trust Royal Preston Hospital Yes Yes Yes Yes No
Leeds Teaching Hospitals NHS Trust Leeds General Infirmary Yes Yes No No Yes
Lewisham and Greenwich NHS Trust Queen Elizabeth Hospital,
Woolwich No Yes No No No
Lewisham and Greenwich NHS Trust University Hospital Lewisham Yes Yes Yes Yes Yes
Maidstone and Tunbridge Wells NHS Trust Tunbridge Wells Hospital No Yes Yes Yes No
Smoking
Manchester University NHS Foundation Trust Royal Manchester Children’s
Hospital Yes Yes No No Yes
Manchester University NHS Foundation Trust Wythenshawe Hospital Yes No Yes Yes No
Mid Cheshire Hospitals NHS Foundation Trust Leighton Hospital Yes No Yes No No
Mid Essex Hospital Services NHS Trust Broomfield Chelmsford Yes Yes Yes No No
Milton Keynes University Hospital NHS
Foundation Trust
Trust Cumberland Infirmary
North Cumbria Integrated Care NHS Foundation
Trust West Cumberland Infirmary No No Yes No No
North Middlesex University Hospital NHS Trust North Middlesex Hospital Yes Yes Yes No No
Smoking
North Tees and Hartlepool NHS Foundation
Trust
Tees No Yes Yes Yes Yes
North West Anglia NHS Foundation Trust Hinchingbrooke Hospital Yes Yes No No Yes
Northampton General Hospital NHS Trust Northampton General
Hospital Yes Yes Yes No No
Northern Devon Healthcare NHS Trust North Devon District Hospital Yes Yes Yes No No
Northern Lincolnshire and Goole NHS
Foundation Trust
Northern Lincolnshire and Goole NHS
Foundation Trust Scunthorpe General Hospital
Yes No No No No
Northumbria Healthcare NHS Foundation Trust Northumbria Specialist
Emergency Care Hospital No Yes Yes Yes No
Pennine Acute Hospitals NHS Trust North Manchester General
Hospital Yes Yes Yes No No
Smoking
Poole Hospital NHS Foundation Trust Poole General Hospital Yes No Yes No Yes
Portsmouth Hospitals NHS Trust Queen Alexandra Hospital No Yes Yes Yes No
Royal Berkshire NHS Foundation Trust Royal Berkshire Hospital Yes No Yes No No
Royal Cornwall Hospitals NHS Trust Royal Cornwall Hospital Yes No Yes No Yes
Royal Devon and Exeter NHS Foundation Trust Royal Devon and Exeter
Hospital Yes No Yes Yes Yes
Royal United Hospitals Bath NHS Foundation
Trust Royal United Hospital Bath
Yes No Yes Yes No
Salford Royal NHS Foundation Trust Salford Royal No No No No No
Salisbury NHS Foundation Trust Salisbury District Hospital Yes Yes Yes Yes No
Smoking
Sandwell and West Birmingham Hospitals NHS
Trust Birmingham City Hospital Yes Yes Yes Yes No
Sandwell and West Birmingham Hospitals NHS
Trust Sandwell District Hospital Yes Yes Yes Yes No
Sheffield Children’s NHS Foundation Trust Sheffield Children’s Hospital Yes No No No Yes
Sherwood Forest Hospitals NHS Foundation
Trust King’s Mill Hospital Yes Yes Yes Yes Yes
South Tees Hospitals NHS Foundation Trust James Cook University
Hospital Yes No Yes Yes Yes
Southend University Hospital NHS Foundation
Trust Southend Hospital
Southport and Ormskirk Hospital NHS Trust Ormskirk District General
Hospital Yes No Yes No Yes
St George’s University Hospitals NHS
Foundation Trust St George’s Hospital Yes Yes Yes No Yes
Smoking
Trust Whiston Hospital Yes Yes Yes Yes No
Stockport NHS Foundation Trust Stepping Hill Hospital No Yes Yes Yes No
Surrey and Sussex Healthcare NHS Trust East Surrey Hospital No No No No No
Tameside and Glossop Integrated Care NHS
Foundation Trust Tameside General Hospital Yes Yes Yes Yes No
Taunton and Somerset NHS Foundation Trust Musgrove Park Hospital Yes No Yes Yes No
The Dudley Group NHS Foundation Trust Russells Hall Hospital Yes Yes Yes Yes No
The Hillingdon Hospitals NHS Foundation Trust Hillingdon Hospital Yes Yes Yes Yes No
The Princess Alexandra Hospital NHS Trust Princess Alexandra Hospital No Yes No No No
Smoking
The Rotherham NHS Foundation Trust Rotherham General Hospital No No No No No
The Royal Wolverhampton NHS Trust New Cross Hospital No Yes Yes Yes No
Torbay and South Devon NHS Foundation Trust Torbay Hospital Yes Yes Yes Yes Yes
United Lincolnshire Hospitals NHS Trust Lincoln County Hospital No Yes No No Yes
United Lincolnshire Hospitals NHS Trust Pilgrim Hospital No No No No Yes
University College London Hospitals NHS
Foundation Trust University College Hospital
Yes Yes Yes Yes Yes
University Hospitals Coventry and Warwickshire
NHS Trust University Hospital Coventry Yes Yes Yes Yes No
University Hospitals of Derby and Burton NHS
Foundation Trust Queen’s Hospital Yes Yes No Yes Yes
Smoking
Foundation Trust Royal Derby Hospital Yes Yes No No Yes
University Hospitals of Morecambe Bay NHS
Foundation Trust Furness General Yes Yes No No Yes
University Hospitals of Morecambe Bay NHS
Foundation Trust Royal Lancaster Infirmary
Yes Yes Yes Yes Yes
University Hospitals of North Midlands NHS
Trust
Hospital Yes Yes Yes Yes Yes
University Hospitals Plymouth NHS Trust Derriford Hospital Yes Yes No No Yes
Walsall Healthcare NHS Trust Manor Hospital Yes Yes Yes Yes Yes
Warrington and Halton Hospitals NHS
Foundation Trust
Hospital Yes No Yes Yes No
West Suffolk NHS Foundation Trust West Suffolk Hospital Yes Yes Yes Yes Yes
Smoking
Western Sussex Hospitals NHS Foundation Trust St Richard’s Hospital Yes Yes No No No
Western Sussex Hospitals NHS Foundation Trust Worthing Hospital Yes Yes No No No
Whittington Health NHS Trust Whittington Hospital Yes Yes Yes Yes Yes
Wirral University Teaching Hospital NHS
Foundation Trust Arrowe Park Hospital Yes Yes No No Yes
Worcestershire Acute Hospitals NHS Trust Worcestershire Royal Hospital No Yes No No Yes
Wrightington, Wigan and Leigh NHS Foundation
Trust Royal Albert Edward Infirmary Yes Yes Yes Yes No
Wye Valley NHS Trust County Hospital Hereford No Yes No No Yes
Yeovil District Hospital NHS Foundation Trust Yeovil District Hospital No Yes Yes Yes No
Smoking
York Teaching Hospital NHS Foundation Trust York District Hospital Yes Yes No No Yes
Scotland
NHS Borders Borders General Hospital Yes No Yes Yes No
NHS Tayside Ninewells Hospital Yes Yes Yes Yes No
Wales
Board Prince Charles Hospital Yes Yes Yes Yes No
Cwm Taf Morgannwg University Local Health
Board Royal Glamorgan Yes Yes Yes No No
Hywel Dda University Local Health Board Bronglais General Hospital No Yes Yes No No
Hywel Dda University Local Health Board Glangwili General Hospital Yes Yes Yes No No
Smoking
Hywel Dda University Local Health Board Withybush General Hospital No Yes Yes No No
Swansea Bay Local Health Board Morriston Hospital Yes Yes Yes Yes Yes
Swansea Bay Local Health Board Princess of Wales Hospital No Yes No No No
8.2 Audit part and non-participation
Partially participating children and young people’s asthma services
Services that provided some organisational audit data but were not included in the final analysis.
Trust / health board Hospital
Bedfordshire Hospitals NHS Foundation Trust Luton and Dunstable Hospital
Cambridge University Hospitals NHS Foundation Trust
Addenbrooke’s Hospital
West Middlesex Hospital
Countess of Chester Hospital
Great Western Hospitals NHS Foundation Trust The Great Western Hospital
Isle of Wight NHS Trust St Mary’s Hospital, Newport
James Paget University Hospitals NHS Foundation Trust
James Paget Hospital
Kettering General Hospital
King’s College Hospital NHS Foundation Trust King’s College Hospital
Mid Yorkshire Hospitals NHS Trust Pinderfields General Hospital
North West Anglia NHS Foundation Trust Peterborough City Hospital
Nottingham University Hospitals NHS Trust Nottingham Children's Hospital (QMC Paediatrics)
Royal Surrey NHS Foundation Trust Royal Surrey County Hospital
South Warwickshire NHS Foundation Trust Warwick Hospital
University Hospital Southampton NHS Foundation Trust
Southampton Children’s Hospital
Scotland
NHS Greater Glasgow & Clyde Royal Hospital for Children
NHS Lothian Royal Hospital for Sick Children (Edinburgh)
Wales
Aneurin Bevan University Local Health Board Nevill Hall Hospital
Betsi Cadwaladr University Local Health Board Ysbyty Gwynedd Hospital
Non-participating children and young people asthma services
Services that provided no organisational audit information.
The hospitals included in this list either did not register for the audit (denoted in grey), or were
registered but did not enter any data for the period reported on in this analysis.
Trust / health board Hospital
England
Alder Hey Children’s NHS Foundation Trust Alder Hey Children’s Hospital
Barts Health NHS Trust The Royal London Hospital
Blackpool Teaching Hospitals NHS Foundation Trust
Victoria hospital
East and North Hertfordshire NHS Trust Lister Hospital
East Cheshire NHS Trust Macclesfield District General Hospital
East Suffolk and North Essex NHS Foundation Trust Colchester General Hospital
East Suffolk and North Essex NHS Foundation Trust
The Ipswich Hospital
Gloucestershire Hospitals NHS Foundation Trust Gloucestershire Royal Hospital
London North West Healthcare NHS Trust Northwick Park Hospital
Medway NHS Foundation Trust Medway Maritime Hospital
Norfolk and Norwich University Hospitals NHS Foundation Trust
Norfolk and Norwich Hospital
Horton General Hospital
John Radcliffe Hospital
Royal Free London NHS Foundation Trust Royal Free Hospital
Shrewsbury and Telford Hospital NHS Trust Princess Royal Hospital, Telford
South Tyneside & Sunderland NHS Foundation Trust
Sunderland Royal Hospital
Great North Children's Hospital
The Queen Elizabeth Hospital
Birmingham Heartlands Hospital
Good Hope Hospital
Bristol Royal Hospital for Children
University Hospitals of Leicester NHS Trust Leicester Royal Infirmary
York Teaching Hospital NHS Foundation Trust Scarborough General Hospital
Scotland
NHS Dumfries & Galloway Dumfries & Galloway Royal Infirmary
NHS Forth Valley Forth Valley Royal Hospital
NHS Grampian Royal Aberdeen Children's Hospital
NHS Grampian Dr Gray’s Hospital
NHS Greater Glasgow & Clyde Royal Alexandra Hospital (Paisley)
NHS Highland Raigmore Hospital
Wales
Cardiff & Vale University Local Health Board University Hospital of Wales
Appendix A – Methodology
Back to contents
Methodology of the audit creation and setup
A national asthma audit was recommended in the 2014 National Review of Asthma Deaths report
following the learnings from the confidential enquiry.4 Subsequently, the Asthma Audit
Development Project (AADP)iv was commissioned between February 2017 and February 2018 to
carry out the groundwork required to set up a national audit of asthma care in adult and paediatric
secondary care services, as well as primary care. This specifically involved the development of
national audit datasets, including the precursor to the current children and young people’s asthma
audit dataset.
The NACAP, which was commissioned from 1 March 2018, launched the children and young people’s
asthma audit in June 2019. This is the first report for this workstream and presents the structure and
resourcing of services between 2 December 2019 and 13 March 2020. The short report, presenting
key findings and recommendations, can be found at www.rcplondon.ac.uk/nacap-cyp-asthma-
2019/20. A quality improvement slide set and patient report is also provided.
All hospitals in England, Scotland and Wales (n=181) that admit children and young people with
asthma attacks were eligible to participate in the organisational audit. Only hospitals registered to
the CYP clinical audit could take part, as completion of the organisational audit took place via the
NACAP audit web tool, where patient data is inputted for the clinical audits.
A total of 162 (90%) hospitals registered for the audit and were therefore able to participate. 119
(66%) hospitals provided a full organisational audit record. A further 23 (13%) provided a partially
complete organisational audit record but were not included in the final analysis. A full list of partially
and non-participating hospitals is provided in Section 8.2.
Recruitment
The recruitment process for this audit started in June 2018 using the following channels:
Communication with hospitals in England and Wales.
Direct communications to health board chief executives / medical directors as well as local
respiratory network leads in Scotland.
Partner and stakeholder channels (such as the BTS’s e-bulletin, and the Association of
Respiratory Nurse Specialists’ newsletter).
NACAP launch information packs and direct letters sent director to trust/health board chief
executives in England, Scotland and Wales.
NACAP twitter and newsletter.
Direct letters to chief executives and medical directors.
The reasons provided to participate in the audits were as follows:
The audit is part of the National Clinical Audit Patient Outcomes Programme (NCAPOP), NHS
iv For more information about the AADP and the development of the initial CYP asthma audit dataset visit:
contracts state that trusts must participate in audits that are part of this programme.
The audit is included in the NHS Wales clinical audit and outcome review plan
(www.wales.nhs.uk/governance-emanual/clinical-governance).
The Care Quality Commission’s (CQC’s) future use of clinical audit metrics in its hospital
inspections in England.
The alignment of the audit to National Institute for Health and Care Excellence (NICE)
guidance.
The fact the audit/s would prove to be a useful tool for facilitating local improvement.
A two-step registration process was followed:
1. All hospitals were required to complete a registration form, providing the contact details and job
title of a ‘clinical lead’ as well as a ‘clinical audit lead’. Web tool accounts were set up for these
contacts by the NACAP team.
2. Hospitals in England and Wales were also required to forward a letter directly to their Caldicott
Guardian. The letter provided an overview of the audit and the legal approvals in place to collect
patient-identifiable data without consent. Caldicott Guardians were required to populate, sign
and return a form to confirm approval in order for eligible hospitals in their trust / health board
to take part. Only after both the registration form and Caldicott Guardian form were completed
did the audit team at the RCP consider the hospital as fully registered and approve hospital
access to the audit web tool.
a. In Scotland, Caldicott Guardian approval was not required for individual hospitals / health
boards as the Public Benefit and Privacy Panel for Health approval is deemed to be the
ultimate information governance authorisation (precluding the need for any others).
Therefore, teams were asked to forward a letter to their Caldicott Guardian for
information purposes only.
The contacts provided within the hospital registration form were registered in the web tool as
having one of two roles: ‘lead clinician’ or ‘data inputter’. The former were able to approve the
creation of new users for that hospital following the launch of the audit, as well as ensure that new
users were suitable from an information governance perspective. The latter were able to create
account requests for new users which required approval by the lead clinician.
The NACAP team chased the registration and Caldicott Guardian forms up to, and post launch of the
audit.
Audit question development and pilot
The audit dataset was developed during the Asthma Audit Development Project (AADP)5 and further
streamlined by the NACAP team and clinical lead, in consultation with the NACAP asthma advisory
group. Following review and incorporation of questions relevant to CYP secondary care services by
the NACAP team, the dataset was circulated to all members of the NACAP asthma advisory group for
comment. Amendments to the dataset were made following return of feedback from the advisory
groups before the dataset went out for public consultation.
The public consultation of the organisational audit dataset took place in July 2019. All registered CYP
audit hospital web tool contacts were notified of the consultation and encouraged to review and
provide feedback on the dataset. On close of the consultation, the dataset was further refined,
amended and finalised.
The final dataset was sent to Crown Informatics, who host the NACAP web tool, to develop an online
organisational audit pro forma where the data could be entered by hospi

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